Complex Patient!

Whilst on my rural placement I had a patient who was referred to outpatient physiotherapy for low back pain. As the initial assessment progressed I was informed that the patient had severe allergies to noise, smell, touch, light, movement, you name it! They told me that they reacted very easily in the form of seizures. The patient stated they had been cleared of epilepsy and after years of extensive medical examinations no definitive diagnosis had been made and doctors were baffled with the patient’s condition. However as the session progressed it was apparent that there were many yellow flags present and I was thus unsure how much of the patient’s condition was medical or psychological.

I begin an objective assessment wherein the patient had frequent bouts of shaking and pain onset. I found that I had to ask the patient’s permission every time I touched them to enquire if they knew if contact on that particular part of their body would cause a seizure. I had to be very clear about my manual contacts and give thorough explanations on what I was doing and why throughout the assessment. Although the patient had underlying mechanical LBP that was applicable to physiotherapy treatment, in retrospect I should have referred the patient straight away once I learned about the extensive “medical” issues.

Thus I have learnt that some patients require more extensive education and explanations throughout assessments and that although some patients have physiotherapy related conditions, overlying medical disorders may need to be dealt with prior to physiotherapy treatment. In the future I will be more definitive about referring patients with medical issues at the onset rather than trying to assess and treat them regardless.